Working Through Sexual Dysfunction after Prostate Cancer

by Leslie R. Schover, PhD

“Working through” is a good description
of a man’s journey with sex
after prostate cancer treatment. With
patience, a willing partner, and openness
to experiment, almost every man
can have pleasurable sex. For most men
or couples, it takes a few months after
surgery, radiation therapy, or hormone
therapy to find their new sexual normal.

Accurate “Sexpectations”
I have
heard too many men express disappointment
about sex after prostate cancer
treatment. At least a third of men consider
sexual function when choosing a
treatment for prostate cancer. As they
search for the best option, they are quoted
rates from medical articles on recovery
of erections. Unfortunately, such articles
are often based on unusually young and
healthy groups of men who start out with
firm, reliable erections. They are treated
by the most expert surgeons or with
the latest radiation techniques. Even
then, reports “fudge” in defining a sexual
success. A man is called “potent” if
he has ever managed to penetrate a partner
sexually since cancer treatment.
Success rates would be far lower if only
men who usually have firm erections
were counted. Men who use pills or injections
to get better erections are also
included in the “success column.” Yet
many of these men are dissatisfied with
sex. Even worse, men given unrealistic
expectations often feel like a failure if
they end up with poor erections.

When it comes to sex after prostate
cancer treatment, there is no free lunch.
All current treatments leave most men
with erectile dysfunction (ED). At least
a third of men with prostate cancer already
have ED because of aging and risk
factors like smoking, being overweight,
heavy drinking, heart disease, high blood
pressure, and diabetes. For these men,
cancer treatment is certainly not going
to improve sex.

When it comes to sex after prostate cancer treatment,
there is no free lunch.

For many years, new prostate cancer
treatments have promised to avoid ED,
including:

nerve-sparing radical prostatectomy;

robotic radical prostatectomy;

brachytherapy (radiation to the prostate
with implanted seeds);

radiation therapy planned by sophisticated
computers;

radiation with proton or photon beams;

drugs that block testosterone from
cancer cells; and

hormone therapy given until a
man’s PSA (prostate-specific antigen)
zeroes out and discontinued until
PSA rises again.

After each of these treatments became
widely used, researchers admitted
that most men ended up with ED. The
only sex-sparing “treatment” for prostate
cancer is active surveillance – waiting
to treat the cancer until tests suggest it
is becoming dangerous to health.

Taking Action to Rescue Your Sex
Life
It does no good to dwell on disappointments.
If a man and his partner
want to have a more active and enjoyable
sex life after prostate cancer, they
have many options.

Choosing the Right Treatment Plan

Not all treatments are the same.
Talk to your doctor to determine your
best plan of action. ♦
Avoid buying ED pills over the
Internet. Most are counterfeit and
can contain harmful chemicals. ♦
Some men’s sex clinics offer overpriced,
assembly-line ED treatment.
Get a referral from your doctors or a
trusted friend.

It is important to get regular blood
flow into the penis after surgery or radiation
therapy to prevent damage to tissue
in the penis. Some men take a daily pill
to enhance erections (PDE5-inhibitors
like Viagra®, Cialis®, or Levitra®). Others
inject medication into the penis to produce
an erection or use a vacuum erection
pump without the constriction band that
maintains the erection for intercourse.
If you have ED, see a specialist. PDE5-inhibitor pills only work for mild ED
after prostate cancer treatment, but penile
injections, vacuum pumps, and surgery
to implant a penile prosthesis (inflatable
erection pump) can restore erections.

Urologists can treat other sexual
problems common after treatment such
as leaking urine at climax or pain with
erection or climax.

Having a partner who enjoys sex is
very important. A mental health professional
trained in sex therapy can help
partners improve sexual communication
and change their lovemaking to make
the most of an ED treatment. Even men
on hormonal therapy may enjoy lovemaking
if they get extra mental and
physical stimulation.

Advice on sex after prostate cancer
can be found in self-help books or websites.
Support groups or peer counseling
programs offer suggestions from men
who have been through the process.

♦ ♦ ♦ ♦ ♦

Dr. Leslie Schover is a clinical
psychologist who has been working with
cancer-related sexual problems for over 30
years. She is professor of Behavioral Science
at The University of Texas MD Anderson
Cancer Center.

This article was published in Coping® with Cancer magazine,
January/February
2012.